Meeting of the New York Psychoanalytic Society

January 26, 1988. THE EVALUATION AND DIAGNOSIS OF SEXUAL ABUSE IN CHILDREN. Susan P. Sherkow, M.D.

Dr. Sherkow noted that in recent years the increasing evidence of sexual abuse of children has created a new field of medico-legal inquiry requiring a new expertise. In the field of psychoanalysis, the specific task is to address the issues of diagnosis and the effect of sexual abuse on intrapsychic dynamics. Dr. Sherkow's hypothesis is that it may be possible to determine early in psychoanalytic treatment whether sexual abuse has taken place. She has observed that the first sessions with little girls who have been sexually abused bear a striking similarity to each other. These sessions are markedly different from the first sessions with children who present with any other chief complaint, both in Dr. Sherkow's practice and when compared to cases presented in the literature. To illustrate her hypothesis, Dr. Sherkow discussed the early months of the analysis of a two-and-a-half-year-old girl whose father was suspected of having molested her.

The child, a lively, verbal, pretty little girl, was brought for evaluation and treatment because her mother had noticed unusual behavior that included genital manipulation, strange body movements, and words to the effect that her father had put "fishes" into her "heinie." She suffered from a sleep disturbance, had frequent temper tantrums, had regressed to the use of a bottle, and played sexualized, thrusting games with dolls that included putting a doll's arm into her vagina. During her first visit, she was interested exclusively in dolls. She undressed all of the dolls and examined their genital areas. She attempted to insert thermometers and "fishes" into the dolls' genitals and into their mouths and called this playing "monster," "doctor," and "daddy." In the next few sessions, this play continued. At times the child said that there were butterflies in her pants, and she looked intense and guilty. She protested str